Two major California health insurers were hit with the state’s largest-ever fines for illegally denying coverage for gender-affirming care in a case that will compel them to revise how they treat patients diagnosed with gender dysphoria.
The $850,000 combined penalties against Blue Cross of California Partnership Plan and its Anthem Blue Cross also require the insurers to hire a dedicated case manager for people with gender dysphoria. Over 150 individuals who were denied coverage for such procedures will see their cases reviewed, and most have already seen reversals, according to the decision.
The insurers are complying with the decision from the Department of Managed Health Care, a state office that regulates their industry.
“We take these matters seriously and have worked directly with the Department of Managed Health Care to identify and implement specific corrective actions to address and resolve the identified matters,” wrote Mike Bowman, a spokesperson for the insurance providers, in a statement to CalMatters.
From 2017 to 2020, two California plans by Anthem Blue Cross and its state partnership categorized over 20 surgeries, such as facial implants, hair removal, voice therapy and breast augmentation, as “not medically necessary.” But the procedures were covered if they corrected “abnormal” body structures to create a “normal appearance” for “the target gender.”
The language the company employed “could create confusion for the reviewers regarding the medical necessity of the 22 procedures,” wrote Sonia R. Fernandes, deputy director and chief counsel office of enforcement at the Department of Managed Healthcare in an Aug. 15 ruling against the Blue Cross of California Partnership Plan.
In a parallel ruling against…
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